干预犬左心房峡部对心房颤动诱发率的影响及其机制研究  

Impact of Intervention in Left Atrial Isthmus on the Inducible Rate of Atrial Fibrillation in Canines and Its Underlying Mechanisms

作　　者：董建增[1] 曹林生[1] 刘小青[1] 龙德勇[2] 刘闯[2] 宁曼[2] 刘兴鹏[3] 马长生[3] 

机构地区：[1]华中科技大学同济医学院附属协和医院心血管病研究所,湖北武汉430022 [2]郑州大学第一附属医院心内科 [3]首都医科大学附属北京安贞医院心内科

出　　处：《中国心脏起搏与心电生理杂志》2003年第5期381-385,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：阐明干预左心房峡部对犬心房颤动 (简称房颤 )诱发率的影响及其与电学隔离Marshall韧带的关系。左心房峡部干预指经开胸手术自左下肺静脉下缘中点沿垂直于冠状静脉窦方向切割至冠状静脉窦上缘 ,切割后缝合关闭切口。共对 19只犬经心外膜途径对Marshall韧带进行标测和对左心房峡部干预。根据干预左心房峡部后Mar shall韧带电位是否消失分为A组 (Marshall韧带电位消失 ,n =12 )和B组 (Marshall韧带电位不消失 ,n =7)。A组干预后房颤诱发率明显降低 (16 .7%vs 83.3% ,P <0 .0 5 ) ;B组干预后房颤诱发率无明显变化 (77.4 %vs 85 .7% ,P >0 .0 5 )。干预左心房峡部后A组房颤诱发率显著低于B组 (16 .7%vs 77.4 % ,P <0 .0 5 )。干预左心房峡部前后左心房峡部传导时间A组 (98.33± 3.2 0msvs 97.5 8± 2 .81ms ,P >0 .0 5 )和B组 (96 .14± 2 .6 1msvs 97.4 2± 3.10ms,P >0 .0 5 )均无明显变化。结论 :干预犬左心房峡部可降低房颤诱发率 ,其机制可能是因电学隔离了Mar shall韧带。To assess the hypothesis that intervention in left atrial isthmus(LAI) could decrease inducible rate of atrial fibrillation(AF) and it′s resulted from concomitant electrical isolation of ligament of Marshall(LOM) in canines,intervention in LAI was carried out through a linear incision from left inferior pulmonary vein to coronary sinus under general anesthesia in 19 normal dogs . Before and after intervention, epicardial mapping of LOM was done with a 10 poles, 2mm inter-electrode space catheter and measuring conduction time of LAI, programed stimulations were applied to different sites. AF induced with same stimulation more than 3 times, and with duration longer than 10 seconds was established as AF inducible, otherwise, it′s non-inducible. Results: LOM potentials could be registered in 100%(19/19) dogs before intervention. After intervention, LOM potentials disappeared in 12 dogs (group A) and retained in 7 dogs (group B),while,the inducible rate of AF was lower (16.7% vs 83.8%, P <0.05) in group A, and no change (77.4% vs 85.5%, P <0.05) in group B. The inducible rate of AF was significantly higher in group B(77.4%) than that in group A(16.7%) after intervention, P <0.05. There was no difference in LAI conduction time before and after intervention in both groups .Conclusions: Intervention in LAI could decrease the inducible rate of AF and it′s resulted from the concomitant electrical isolation of LOM, not resulted from conduction block of LAI.

关 键 词：犬 左心房峡部 心房颤动 诱发率 电学隔离 MARSHALL韧带 手术方式 

分 类 号：R654.2[医药卫生—外科学]